Induced Abortion – A Continuing Threat to Maternal Life

Abstract

Background: In Pakistan, therapeutic induced abortion is a controversial issue and continued to be a significant contributor of maternal mortality and morbidity. The aim of the present study is to assess the magnitude of septic abortion in a tertiary care hospital over a period of 2 years with special emphasis on maternal mortality and morbidity.

Objectives: This prospective study was aimed to determine the frequency of induced abortion, to know the reason for requesting abortion, assess the associated maternal morbidity and mortality in our setup.

Study Design: Descriptive Study.

Place and Duration of Study: This Study was conducted at the Department of OBGY, PUMHSW Nawabshah from 1^st January 2009 to 31^st December 2010.

Materials and Methods: Hospital record of patients who were admitted with unsafe abortions in     2 years (2009 – 2010) were reviewed to evaluate the demographic and clinical profile in relation to age, parity, marital status, indication and method of abortion, qualification of abortion provider and maternal mortality.

Result: Unsafe abortion contributes 4.4 % of total patients admitted with abortion over 2 years. Mean age of them was found ± SD 30.14 + 8.56 and mean parity was 6.07 ± 3.00. 78.6 % patients belong to poor community and     > 70 % patients were married and used it as a method of contraception. Uterine instrumentation was the commonest method (78 %) used to induce abortion.

Majority of women were admitted with life threatening complications like haemorrhage (75 %), sepsis (53.57 %), hypovolumic shock (39.28 %) and faecal peritonitis in 21.42 %. DIC in 10.71 %, uterine perforation in   28.57 % and mortality in 4 (14.28 %). 5 (17.85 %) were managed conservatively, 13 (46.42 %) had re-evacuation, 10 patients had exploratory laparotomy, out of them 2 needed peritoneum toilet, while in 5 patients gut resection and anastomosis and in one permanent colostomy was done. Uterine trauma found in 8 patients (28.57 %) in whom 3 (10.70 %) ended up in hysterectomy. Unsafe abortion contribute 14.28 % of death in study group.

Conclusion: The present study conclude that unsafe abortion is a major neglected health issue needs attention and high degree of commitment. Its elimination requires advocacy, policies to support woman right and improving access to family planning services.